Cost-related medication nonadherence declined among Medicare enrollees following implementation of the Inflation Reduction Act’s prescription drug provisions in 2024, according to a study published March 9 in JAMA Internal Medicine.
Enrollees’ cost-related medication nonadherence fell by an estimated 4.9 percentage points relative to privately insured comparators after the provisions took effect. Among Medicare Part D beneficiaries, nonadherence stood at 8.2% in the three years prior to the provisions and fell to 5.7% in 2024. The effect was even more pronounced among enrollees managing at least two chronic conditions, who saw nonadherence fall by nearly 8 percentage points.
Meanwhile, cost-related nonadherence rose among the privately insured comparator group, climbing from 4.5% to 6.8% over the same period.
“These early improvements may have important implications for chronic disease management and downstream clinical outcomes,” researchers wrote.
The study focused on two IRA provisions that took effect Jan. 1, 2024: the elimination of the 5% coinsurance requirement for catastrophic coverage — which effectively capped annual out-of-pocket prescription drug costs at roughly $3,300 — and the expansion of full Part D low-income subsidies to beneficiaries earning between 135% and 150% of the federal poverty level.
When looking at broader healthcare-related financial strain, such as difficulty paying or worry about medical bills, researchers found no meaningful differential changes between the two groups.
The analysis drew on data from the CDC’s 2021-2024 National Health Interview Survey and included 1,454 Medicare Part D beneficiaries and 3,797 privately insured adults, all between the ages of 62 and 67. Researchers used a difference-in-differences design to compare outcomes before and after the policy changes. Individuals earning 135% or less of the federal poverty level, those dually enrolled in Medicaid and current insulin users were excluded from the primary analysis.
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